Protocol-based management of acute chest pain to reduce door-to-balloon time: insights from a tertiary care emergency department

Abstract

Background: Chest pain is among the most common reasons patients visit the emergency department (ED). Any new onset of chest pain or any change in the pattern, intensity, or duration of pain in patients with preexisting symptoms must be evaluated to rule out acute coronary syndrome (ACS). Materials and Methods: This study was conducted at the ED of a 250-bed tertiary care center in North India. All patients presenting to the ED with acute chest pain were evaluated using a strictly protocolized approach. The study lasted from October 1, 2021, to December 31, 2022. Patients diagnosed with ST-segment elevation myocardial infarction (STEMI) were included in the study. Key timelines recorded included the time of patient arrival, time to electrocardiogram (ECG), time to transfer to the cardiac catheterization laboratory (CCL), and time to catheterization in the CCL. Results: A total of 208 patients presenting to the ED with acute chest pain were diagnosed with STEMI. The mean door-to-ECG time was 2.96 min, door-to-CCL time was 35.02 min, and door-to-balloon (DTB) time was 65.36 min. Additionally, 86.1% of patients had a DTB time of <90 min. Conclusion: STEMI patients are considered the most vulnerable among those with ACS. Nearly three million STEMI cases occur in India each year. Hospitals providing STEMI care can strengthen protocols to meet recommended timelines and ensure better patient care. Utilizing technology and adapting to local needs can help improve STEMI outcomes and contribute to developing an integrated national policy.

Keywords

• acute coronary syndrome; chest pain; emergency department; stemi